Patient-Satisfaction Surveys on a Scale of 0 to 10: Improving Health Care, or Leading It Astray?
Alexandra Junewicz and Stuart J. Youngner

It is increasingly common for patient-satisfaction surveys to be used as indicators of health care quality, as well as to influence the reimbursement paid to providers. But the authors argue that the surveys could eventually compromise the quality of care and raise health care costs. "The pursuit of high patient-satisfaction scores may actually lead health professionals and institutions to practice bad medicine by honoring patient requests for unnecessary and even harmful treatments," they write. "Patient satisfaction is important, especially when it is a response to being treated with dignity and respect, and patient-satisfaction surveys have a valuable place in evaluating health care. Nonetheless, some uses and consequences of these surveys may actively mislead health care." Junewicz is a resident physician in the Department of Psychiatry at the New York University School of Medicine. Youngner is a professor of bioethics and psychiatry in the Department of Bioethics at Case Western Reserve University School of Medicine.

Nurses, physicians, and other health care professionals confront many moral challenges in which they feel they must act courageously to "do the right thing," stand up for patients' rights, and uphold the ethical standards of their professions. In particular, the authors write, health care providers are increasingly reminded of their moral duty to exhibit courage in the face of institutional obstacles to the proper care of their patients. If, for example, a nurse feels that an agitated patient would benefit from increased sedation, should she ask for it from a doctor, even if she knows that the doctor will hold that request against her? Failure to do so would indicate a lack of courage, according to an article cited by the authors, who offer a critical assessment of such appeals to courage. "While we find courage to be an indispensable virtue in some challenging contexts, in other settings we find invocations of courage to be both an unfortunate endorsement of an oppressive status quo that can divert attention from the real problems and an undesirable and potentially destructive strategy within health care institutions whose goal is medically excellent and morally good clinical practice," they write. "As we shall argue, a call to virtuousness is not always virtuous." Hamric is associate dean for academic affairs and a professor at the Virginia Commonwealth University School of Nursing. Arras, who died in March, was the Porterfield Professor of Biomedical Ethics and a professor of philosophy and public health sciences at the University of Virginia. Mohrmann is a professor of pediatrics, medical education, and religious studies at the University of Virginia.

"A patient arrives in the emergency room apparently in a comatose state. But is he really unconscious or just faking? The young doctors on duty are skeptical. Failing to get a reaction with a chest rub, they try a variety of methods that become increasingly sadistic--pressing on the patient's fingernail with a ballpoint pen, spraying his testicles with a skin-freezing compound, announcing an imminent eye injection to scare the patient awake." The story was told in a 2012 graphic novel called Disrepute, part of a growing genre called "graphic medicine." Doctors, nurses, and patients are using the graphic novel form to reveal the dark underbelly of medicine, writes Glazer, a contributing writer for CQ Researcher. In a related article, Graphic Medicne in the University, Susan M. Squier, discusses her experience offering a graduate seminar on graphic medicine. "What happened surprised me," writes Squier, the Brill Professor of Women's Studies and English at Pennsylvania State University. "Not only did the students, none of whom were medical students, explore illness, disability, and medical treatment in their comics, but they often articulated bioethics issues as well."

Five states have adopted "right to try" laws intended to promote terminally ill patients' access to investigational drugs. Many more state legislatures are now considering such laws. The campaign for right to try laws is the latest move in an ongoing effort to give seriously ill patients access to drugs whose safety and effectiveness remain largely unknown. Although scientists and policy-makers oppose the right to try approach, it has proven quite popular among state legislators and the public.

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